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박병훈 ( Byung Hoon Park ),박선철 ( Seon Cheol Park ),신상윤 ( Sang Yun Shin ),전한호 ( Han Ho Jeon ),정경수 ( Kyung Soo Jung ),정우영 ( Woo Young Jung ),변민광 ( Min Kwang Byun ),문지애 ( Ji Ae Moon ),김영삼 ( Young Sam Kim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.6
Sarcoidosis is a multi-systemic syndrome of an unknown etiology, and it is characterized by the formation of multiple noncaseating granulomas that disrupt the architecture and function of the tissues in which they reside. The most commonly affected organs are lung, skin and lymph nodes. Overt clinical involvement of the nervous system is uncommon and this occurs in about 5% of all patients during the course of their disease. The most common manifestations are granulomatous leptomeningitis, cranial nerve palsy, electrolyte or other endocrinologic abnormalities, but isolated memory impairment is a rare manifestation. This is a case of 59 years-old male with recent memory impairment, and he was previously diagnosed with pulmonary sarcoidosis by transbronchial lung biopsy. The brain MRI imaging revealed the leptomeningeal and parenchymal involvement of sarcoidosis. He was treated with high dose corticosteroid and his memory function was improved to nearly a normal level. We report here on a case of successful treatment of pulmonary sarcoidosis combined with neurosarcoidosis with using high dose corticosteroid, and the patient presented with recent memory impairment. (Tuberc Respir Dis 2007; 62: 549-553)
한국 성인을 대상으로 한 미국 및 유럽 폐활량 검사 재현성 기준의 유용성
박병훈 ( Byung Hoon Park ),박무석 ( Moo Suk Park ),정우영 ( Woo Young Jung ),변민광 ( Min Kwang Byun ),박선철 ( Seon Cheol Park ),신상윤 ( Sang Yun Shin ),전한호 ( Han Ho Jeon ),정경수 ( Kyung Soo Jung ),문지애 ( Ji Ae Moon ),김 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5
연구배경: 본 연구를 통해 2005년도 ATS/ERS 폐활량검사 지침에서 제시한 재현성 기준을 한국 성인들에게 적용할 수 있는 지와, 한국 성인들의 폐활량 검사 시 재현성에 영향을 미치는 요인들을 알아보고자 하였다. 방 법: 국민건강영양조사, COPD 코호트, 지역사회 코호트로부터 얻은 성인 4,663명의 폐활량검사 결과를 이용하여 dFVC 및 dFEV1를 계산하여 분포를 알아보고, 1994년도 ATS 지침 및 2005년도 ATS/ERS 지침을 만족하는 검사의 비율을 비교하였다. 다중회귀분석을 통해 개인적 특성 및 재현성 기준의 변화가 재현성에 영향을 미치는가를 알아보았다. 결 과: 폐활량검사를 시행한 사람들 중 95% 이상이 150ml 이내의 재현성 기준을 만족시켰다. 1994년도 ATS 지침에 따라 검사를 시행한 경우 재현성을 만족하지 않는 경우가 증가하였다. 다중회귀분석 결과 재현성에 영향을 주는 요인들은 신장, 연령, 체중, 폐쇄성폐질환 여부, 재현성 기준의 변화 등이었으나 재현성에 영향을 미치는 정도는 매우 작았다(0.5∼3.0%). 결 론: 한국인에게도 2005년도 ATS/ERS에서 제시한 재현성 기준을 적용할 수 있을 것으로 생각하며, 이를 위해서는 변경된 재현성 기준에 대한 지속적인 홍보와 검사자 들에 대한 교육 및 정도 관리가 필요하다. Background: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. Methods: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV1 (dFEV1) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV1, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spiro-metric variability. Results: About 95% of subjects were able to reproduce FVC and FEV1 within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. Conclusion: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results. (Tuberc Respir Dis 2007;63:405-411)
Btk 유전자 인트론 2 돌연변이에 의한 X연관 무감마글로불린혈증
정문재 ( Moon Jae Chung ),정지예 ( Ji Ye Jung ),손지영 ( Ji Young Son ),구철룡 ( Cheol Ryong Ku ),박병훈 ( Byung Hoon Park ),변민광 ( Min Kwang Byun ),문지애 ( Ji Ae Moon ),김영삼 ( Young Sam Kim ),김세규 ( Se Kyu Kim ),장준 ( Jo 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.3
X-linked agammaglobulinemia is the most common type of primary immunodeficiency disorder. Mutation ofthe cytoplasmic tyrosine kinase gene, Btk (Bruton`s tyrosine kinase), is known to be the etiology of X-linked agammaglobulinemia. The patients with this disease manifest a B-cell deficiency and low levels of serum immunoglobulin; due to the deficient antibodies, they suffers from recurrent upper and lower respiratory infections. We report here a 24-year-old male with an initial clinical impression of recurrent pneumonia and bronchiectasis. The patient presented with marked pan-hypogammaglobulinemia and the absence of circulating B-lymphocytes on the immunologic study, and he carried a splicing mutation of intron 2 in the Btk gene (IVS2 -3C>G). (Tuberc Respir Dis 2008;65:207-211)
이달의 X-선 : 다발 전이성 농양을 일으킨 편평상피세포암성 농양 1예
임주은 ( Ju Eun Lim ),김은영 ( Eun Young Kim ),장지은 ( Ji Eun Jang ),손지영 ( Ji Young Son ),정지예 ( Ji Ye Jung ),박병훈 ( Byung Hoon Park ),이경종 ( Kyung Jong Lee ),윤여운 ( Yoe Wun Yoon ),변민광 ( Min Kwang Byun ),이사라 ( Sa 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.5
기관지폐쇄에 의한 폐농양 혹은 공동성 병변에 발생한 암성 농양은 임상 양상 및 방사선학적 소견이 흡인성 폐농양과 흡사하여 감별이 어려워서 폐암을 조기 진단할 수 있는 기회를 놓치기 쉽다. 따라서 항생제에 대한 반응이 뚜렷하지 않거나 선행 요인이 없고 비전형적인 위치에 발생한 폐농양의 경우 악성 병변의 동반 가능성을 염두에 두고 적극적인 검사가 필요하다. 저자들은 발열, 기침, 혈담, 호흡곤란을 주소로 내원하여 폐농양 의심하에 항생제치료에도 불구하고 병변이 악화된 67세 남자 환자에서 간세침흡인생검을 통해 다발 전이성 농양을 일으킨 편평상피세포암성 농양으로 진단된 예가 있어 문헌 고찰과 함께 보고하는 바이다. Among the bronchogenic carcinomas, especially squamous cell carcinoma and large cell carcinoma frequently present with cavitation, which may result from tumor necrosis. Cavitary lesions of the tumor are occasionally associated with infection and misdiagnosed as benign lung abscess owing to the partial responsiveness to antibiotics. It is very difficult to distinguish the carcinomatous abscess from the benign lung abscess, because of their similar clinical and radiologic features. Delay in diagnosis of underlying lung cancer may result in poor outcome. Therefore, clinicians should remember that the patients with highly suspicious carcinoma of the lung should undergo further precise examinations to find out malignant cells.
우중하엽 폐허탈 및 폐쇄세기관지기질화 폐렴을 유발한 기관지 지방종
손지영 ( Ji Young Son ),정지예 ( Ji Ye Jung ),하유정 ( You Jung Ha ),홍수정 ( Soo Jung Hong ),정민규 ( Min Kyu Jung ),정문재 ( Moon Jae Chung ),서용성 ( Yong Sung Seo ),문지애 ( Ji Ae Moon ),변민광 ( Min Kwang Byun ),박병훈 ( Byun 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.4
Lipoma is a common neoplasm in soft tissues. However, an intrapulmonary lipoma is a rare benign tumor. Patients with a bronchial lipoma might have a malignant potential related to their smoking history due to the case reports of lung cancer accompanied with lipoma. Endobronchial lipoma can cause irreversible parenchymal lung damage if not diagnosed and treated early. Therefore, it should initially be treated by fiberoptic bronchoscopy or surgery depending on the status of distal parenchymal lung damage. Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome that is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal air spaces. BOOP is caused by drug intoxication, connective tissue disease, infection, obstructive pneumonia, tumors, or an unknown etiology. We encountered a 58 year-old male patient with endobronchial lipoma, causing the collapse of the right middle and lower lobes, and BOOP due to obstructive pneumonia. (Tuberc Respir Dis 2008;65:313-317)